1
|
Grobost V, Hammi S, Pereira B, Guilhem A, Duffau P, Seguier J, Parrot A, Gautier G, Alric L, Kerjouan M, Le Guillou X, Simon D, Chaussavoine L, Rondeau-Lutz M, Leguy-Seguin V, Delagrange L, Lavigne C, Maillard H, Dupuis-Girod S. Antiplatelet and anticoagulant therapies in hereditary hemorrhagic telangiectasia: A large French cohort study (RETROPLACOTEL). Thromb Res 2023; 229:107-113. [PMID: 37437516 DOI: 10.1016/j.thromres.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/02/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND It is unclear whether hereditary hemorrhagic telangiectasia (HHT) patients can tolerate antithrombotic therapies (AT) including antiplatelet (AP) and/or anticoagulant (AC) agents. OBJECTIVES Primary endpoint was tolerance to AT in HHT. Secondary endpoints were to identify factors associated with major bleeding events (MBE) and premature discontinuation of AT. METHODS Retrospective multicenter study in French national HHT Registry patients exposed to AT. RESULTS We included 126 patients with 180 courses of AT. Median follow-up was 24 [11-52] months. Mean age was 65.6 ± 13.1 years. The first 3 months of AT exposure had an increased risk of hospitalization for hemorrhage (p < 0.001) and transfusions (p < 0.001). MBE (n = 63) occurred more frequently in the first 3 months of AT exposure (p < 0.001). Premature discontinuation of AT occurred in 61 cases. Rate of premature discontinuation was 29 % under both AP and AT therapy but significantly higher under dual AP therapy (n = 4/7, 57 % p = 0.008). Risk factors for MBE were: age ≥ 60 years (HR 2.34 [1.12;4.87], p = 0.023), prior hospitalization in the 3 months before starting AT for hemorrhage (HR 3.59 [1.93;6.66], p < 0.001) or transfusion (HR 3.15 [1.61;6.18], p = 0.001), previous history of gastro-intestinal bleeding (HR 2.71 [1.57;4.65], p < 0.001) or MBE (HR 4.62 [2.68;7.98], p < 0.001). Frequency of MBE did not differ between groups except for a higher risk in the dual AP group (HR 3.92 [1.37;11.22], p = 0.011). CONCLUSION Tolerance of AC or AP therapy was similar in HHT population but not dual AP therapy. We identified risk factors for MBE occurrence or premature discontinuation under AT.
Collapse
Affiliation(s)
- Vincent Grobost
- Service de Médecine Interne, Clermont-Ferrand University Hospital, CHU Estaing, 63000 Clermont-Ferrand, France.
| | - Sami Hammi
- Department of Internal Medicine, Angers University Hospital, 49100 Angers, France
| | - Bruno Pereira
- Biostatistics Unit, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Alexandre Guilhem
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France
| | - Pierre Duffau
- Bordeaux University Hospital, Internal Medicine and Clinical Immunology Department, Université de Bordeaux, CNRS ImmunoConcEpT UMR 5164, 33000 Bordeaux, France
| | - Julie Seguier
- Département de Médecine Interne, Marseille University Hospital, 13000 Marseille, France
| | - Antoine Parrot
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie et Centre de Compétence de la Maladie de Rendu Osler, Hôpital Tenon, 75020 Paris, France
| | - Giovanni Gautier
- Nantes Université, Nantes University Hospital, Department of Internal and Vascular Medicine, 44000 Nantes, France
| | - Laurent Alric
- Internal Medicine-Digestive Medicine, CHU Rangueil Toulouse 3 University, 31000 Toulouse, France
| | - Mallorie Kerjouan
- Service de Pneumologie, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France
| | - Xavier Le Guillou
- Medical Genetics Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Delphine Simon
- Service de Médecine Interne, CHU Charles Nicolle, 76000 Rouen, France
| | - Laurent Chaussavoine
- Centre Hospitalier Universitaire de Caen Normandie, Service de Médecine Vasculaire, 14000 Caen, France
| | - Murielle Rondeau-Lutz
- Service de Médecine Interne, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67 091 Strasbourg cedex, France
| | | | - Laura Delagrange
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France
| | - Christian Lavigne
- Department of Internal Medicine, Angers University Hospital, 49100 Angers, France
| | - Hélène Maillard
- Department of Internal Medicine and Clinical Immunology, Referral Centre for rare systemic autoimmune diseases for North and North-West France (CeRAINO), CHU Lille, 59000, Lille, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France
| |
Collapse
|
2
|
Le TTT, Martinent G, Dupuis-Girod S, Parrot A, Contis A, Riviere S, Chinet T, Grobost V, Espitia O, Dussardier-Gilbert B, Alric L, Armengol G, Maillard H, Leguy-Seguin V, Leroy S, Rondeau-Lutz M, Lavigne C, Mohamed S, Chaussavoine L, Magro P, Seguier J, Kerjouan M, Fourdrinoy S. Development and validation of a quality of life measurement scale specific to hereditary hemorrhagic telangiectasia: the QoL-HHT. Orphanet J Rare Dis 2022; 17:281. [PMID: 35854330 PMCID: PMC9295423 DOI: 10.1186/s13023-022-02426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) disease is a rare genetic disorder with symptoms and complications that can significantly affect patients’ daily lives. To date, no scale has been validated to assess the specific symptoms of this disease on the quality of life (QOL) of HHT patients. This makes it difficult for clinicians to accurately measure the quality of life of patients with HHT. The present study aims to develop and validate a QOL measurement tool specific to HHT disease: the QOL questionnaire in HHT (QoL-HHT). Methods A quantitative, non-interventional, multi-center study involving HHT patients in twenty French HHT expert centers was conducted. A calibration sample of 415 HHT patients and a validation sample of 228 HHT patients voluntarily participated in the study. Data were analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Exploratory Structural Equation Modeling (ESEM) analyses, reliability analyses, and correlational analyses. Results The EFA, CFA and ESEM results allowed us to provide evidence of the factorial structure of a questionnaire composed of 24 items measuring 6 domains of QOL: Physical limitations, social relationships, concern about bleeding, relationship with the medical profession, experience of symptoms, and concern about the evolution of the disease. Cronbach’s alpha coefficients (> 0.70) demonstrated reliable internal consistency of all the QoL-HHT scores (dimensions). The results of the test–retest provided further evidence of the reliability of the QOL-HHT scores over time. Correlational analyses provided evidence for the convergent validity of the QoL-HHT scores. Conclusions We developed a simple and quick self-assessment tool to measure quality of life specific to HHT disease. This study demonstrated reliability and validity of our QoL-HHT scores. It is a very promising tool to evaluate the impact of HHT disease on all aspects of the quality of life of HHT patients in order to offer them individualized medico-psycho-social support. Trial registration: ClinicalTrials, NCT03695874. Registered 04 October 2018, https://www.clinicaltrials.gov/ct2/show/NCT03695874 Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02426-2.
Collapse
Affiliation(s)
- Thi Thao Truc Le
- Laboratoire de Psychologie sur les Dynamiques Relationnelles et Processus Identitaires (EA 7458), Université de Bourgogne-Franche-Comté, 3 Allée des Stades Universitaires, 21000, Dijon, France
| | - Guillaume Martinent
- Laboratoire sur les Vulnérabilités et l'Innovation dans le Sport (EA 7428), Université de Lyon, Université Claude Bernard Lyon 1, 27-29 bd du 11 Novembre 1918, 69622, Villeurbanne, France
| | - Sophie Dupuis-Girod
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France
| | - Antoine Parrot
- Service de pneumologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 rue de Chine, 75790, Paris Cedex 20, France
| | - Anne Contis
- Service de médecine interne, Hôpital Saint André, 1 rue Jean Burguet, 33000, Bordeaux, France
| | - Sophie Riviere
- Service de médecine interne, CHU de Montpellier Hôpital St Eloi, Avenue A. Fliche, 34295, Montpellier Cedex 5, France
| | - Thierry Chinet
- Consultation Maladie de Rendu-Osler, CHU Ambroise Paré, 9 av Charles de Gaulle, 92104, Boulogne Billancourt, France
| | - Vincent Grobost
- Service de médecine interne, CHU Estaing, 1 rue Lucie et Raymond Aubrac, 63100, Clermont-Ferrand, France
| | - Olivier Espitia
- Service de médecine interne - médecine vasculaire, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Laurent Alric
- Service de médecine interne, CHU Rangueil, 1 av du Pr Jean Poulhès, 31059, Toulouse Cedex 9, France
| | - Guillaume Armengol
- Service de médecine interne, CHU de Rouen Ch. Nicolle, , 1 rue de Germont, 76031, Rouen Cedex, France
| | - Hélène Maillard
- Service de médecine interne, Hôpital Huriez, 1 rue Michel Polonovski, 59037, LILLE Cedex, France
| | - Vanessa Leguy-Seguin
- Service de médecine interne, Hôpital Le Bocage, 2 Bd Maréchal de Lattre de Tassigny, BP 77908, 21079, Dijon Cedex, France
| | - Sylvie Leroy
- Service de pneumologie, CHU de Nice, 30 av de la Voie Romaine, 06002, Nice Cedex, France
| | - Murielle Rondeau-Lutz
- Service de médecine interne, CHU de Strasbourg Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Christian Lavigne
- Service de médecine interne, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex 09, France
| | - Shirine Mohamed
- Service de médecine interne, CHU de Nancy, Hôpital Brabois, Rue du Morvan, 54511, Vandoeuvre Les Nancy, France
| | - Laurent Chaussavoine
- Service de médecine vasculaire, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Pascal Magro
- Service de pneumologie, CHRU de Tours Hôpital Bretonneau, 2 bd Tonnellé, 37044, Tours Cedex 9, France
| | - Julie Seguier
- Service de médecine interne, Hôpital de La Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France
| | - Mallorie Kerjouan
- Service de pneumologie, CHU de Rennes Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 09, France
| | - Sylvie Fourdrinoy
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France.
| |
Collapse
|
3
|
Trihan JE, Adam M, Jidal S, Aichoun I, Coudray S, Laurent J, Chaussavoine L, Chausserie S, Guillaumat J, Lanéelle D, Perez-Martin A. Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study. Vasc Med 2021; 26:288-296. [PMID: 33749393 DOI: 10.1177/1358863x21994672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score's accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% (p = 0.22) and 1.7%, 4.2% and 25.8% (p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.
Collapse
Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Department, University Hospital Poitiers, Poitiers, France
| | - Michael Adam
- Vascular Medicine Department, University Hospital Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Sara Jidal
- Vascular Medicine Department, University Hospital Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Isabelle Aichoun
- Vascular Medicine Department, University Hospital Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Sarah Coudray
- Vascular Medicine Department, University Hospital Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Jeremy Laurent
- Vascular Medicine Department, University Hospital Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Laurent Chaussavoine
- Vascular Medicine Department, University Hospital Caen, Caen, Basse-Normandie, France
| | - Sebastien Chausserie
- Vascular Medicine Department, University Hospital Caen, Caen, Basse-Normandie, France
| | - Jerome Guillaumat
- Vascular Medicine Department, University Hospital Caen, Caen, Basse-Normandie, France
| | - Damien Lanéelle
- Vascular Medicine Department, University Hospital Caen, Caen, Basse-Normandie, France
| | - Antonia Perez-Martin
- Vascular Medicine Department, University Hospital Nîmes, Nîmes, Languedoc-Roussillon, France
| |
Collapse
|